MULTIFOCAL TUBERCULOSIS - A REVIEW OF 49 CASES SEEN IN THE CENTER-WEST REGION OF FRANCE (GERICCO, 1991-1993)

Diffuse or multifocal tuberculosis (TB) accounts for 9% to 10% of case s of extrapulmonary TB and carries a poor prognosis with a mortality r ate of 16% to 25%. Forty-nine cases of multifocal TB defined as involv ement Of two extrapulmonary sites with or without pulmonary TB were re viewed. Mean patient age (+/-SD) was 50+/-18 years. Twenty-three per c ent of patients were immigrants. A history of TB and contact with a TB patient were found in 23% and 18% of cases, respectively. Of the 52% of immunocompromised patients, 38% were HIV-positive. The skin tubercu lin test was positive in 67% of cases. Mean time from symptom onset to admission was 80+/-77 days (median, 58 days). The 49 patients had a t otal of 128 TB foci. Six patients had positive blood cultures. The tub ercle bacillus was recovered from the extrapulmonary sites in 88% of c ases. Mean treatment duration was nine months. Recovery from the TB wa s achieved in 64% of cases. The overall mortality rate was 47%, and 33 % of patients died as the direct result of TB. Most deaths occurred in immunocompromised patients. A high index of suspicion for multifocal TB should be maintained in immunocompromised patients, even those who test negative for the HN.